THE NEED AND DEMAND FOR RENAL REPLACEMENT THERAPY IN ETHNIC-MINORITIES IN ENGLAND

Study objective - The study aimed to determine the relative risk of be ing accepted for renal replacement treatment of black and Asian popula tions compared with whites in relation to age, sex, and underlying cau se, The implications for population need for renal replacement therapy in these populations and for the development of renal services were a lso considered. Design/setting - This was a cross sectional retrospect ive survey of all patients accepted for renal replacement treatment in renal units in England in 1991 and 1992. Patients - These comprised a ll 5901 patients resident in England with endstage renal failure who h ad been accepted for renal replacement therapy in renal units in Engla nd and whose ethnic category was available from the units. Patients we re categorised as white, Asian, black, or other. Population denominato rs for the ethnic populations were taken from the 1991 census. The cen sus categories indian, Pakistani, and Bangladeshi were aggregated to f orm the denominator for Asian patients, and black Caribbeans, black Af ricans, and black others were aggregated to form the denominator for b lack patients. Main result - Altogether 7.7% of patients accepted were Asian and 4.7% were black; crude relative acceptance rates compared w ith whites were 3.5 and 3.2 respectively. Ape sex specific relative ac ceptance ratios increased with age in both ethnic populations and were greater in females. Age standardised acceptance ratios were increased 4.2 and 3.7 times in Asian and black people respectively. The mast co mmon underlaying cause in both these populations was diabetes; relativ e rates of acceptance for diabetic end-stage renal failure were 5.8 an d 6.5 respectively. The European Dialysis and Transplant Association c oding system was inaccurate for disaggregating nan-insulin and insulin dependent forms; ''Unknown causes'' were an Important category in Asi ans with a relative acceptance of rate 5.7. The relative rates were re duced only slightly when the comparison was confined to the district h ealth authorities with large ethnic minority populations, suggesting t hat geographical access was not a major factor in the high rates for e thnic minorities. Conclusion - Acceptance rates for renal replacement treatment are increased significanfly in Asian and black populations. Although data inaccuracies and access factors may contribute to these findings, the main reason is probably the higher incidence of end-stag e renal failure. This in turn is due to the greater prevalence of unde rlying diseases such as non-insulin dependent diabetes but possibly al so increased susceptibility of developing nethropathy. The main implic ation is that these populations age demand for renal replacement treat ment will increase. This will have an impact nationally but will be pa rticularly apparent in areas with large ethnic minority populations. F uture planning must take these factors into account and should include strategies for preventing chronic renal failure, especially that due to non-insulin dependent diabetes and hypertension. The data could not determine the extent to which population need was being met; further studies are required to estimate the incidence of endstage renal failu re in ethnic minority populations.